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Long Z, Song R, Zhao C, Miao Y, Luo X, Wu X, Huang D, Zhang L. Quantifiable design and comparative evaluation of straight-line minimally invasive endodontic cavity based on the anatomical features of the coronal part of root canal. J Dent Sci 2023; 18:1621-1629. [PMID: 37799919 PMCID: PMC10547998 DOI: 10.1016/j.jds.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
Background/purpose Minimally invasive endodontics has recently become popular in research. This study aimed to develop a new quantifiable straight-line minimally invasive endodontic cavity (SMIEC) for 3-rooted maxillary first molar based on the anatomical features of the coronal part of root canal. Materials and methods Cone-beam computed tomography (CBCT) images of 80 teeth were converted into models in Mimics Research software. Anatomical features of the coronal part of root canal were measured to develop SMIECs with straight-line accesses to root canals in 3-matic Research software. Twenty models were randomly sampled and each was duplicated for 8 simulation groups: non-treated (NT), traditional endodontic cavity (TEC), ninja endodontic cavity (NEC) and 5 SMIECs. Post-simulation models were subjected to finite element analysis to detect von-Mises stresses in ABAQUS software. Results Distributions of straight-line accesses to protogenetic root canals had certain manners, hence we developed 5 SMIECs. NEC and SMIECs had less hard tissue loss than TEC and presented different numerical rankings in different structures (P < 0.05). NEC had a less narrow surgery field than SMIECs except SMIEC2/4 (P < 0.05). The peak pericervical stresses of SMIECs were similar, lower than TEC and higher than NEC and NT (P < 0.05). The stress distributions of the 8 groups had certain manners. Conclusion Five SMIECs with straight-line accesses to root canals were developed, whose biomechanical properties were worse than NEC but better than TEC. Having appropriate structure preservation and surgery field, SMIEC2/4 was a preferred SMIEC.
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Affiliation(s)
- Ziteng Long
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Ruijun Song
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Chenyi Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Yixuan Miao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Xutao Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Xingbo Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Dingming Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Lan Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
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Fracture resistance and biomechanical behavior of different access cavities of maxillary central incisors restored with different composite resins. Clin Oral Investig 2022; 26:6295-6303. [PMID: 35713701 DOI: 10.1007/s00784-022-04581-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of this study was to compare the effect of three different access cavities on the tissue removal, deflection, fracture resistance, and stress distribution of extracted maxillary central incisors. MATERIALS AND METHODS Forty human maxillary central incisors were randomly assigned in four experimental group (n = 10) including conservative access cavity "CAC," traditional access cavity "TAC," invasive access cavity "IAC," and without access cavity (control group). Cone-beam computed tomography "CBCT" scans were used to evaluate the tissue removal during the different access cavities. All specimens were restored with composite resin (Admira Fusion, Voco, Cuxhaven, Germany) and embedded in acrylic resin blocks after simulating the periodontal ligament using red wax, then the specimens were submitted to the deflection test applying a load of 250 N and to the load-to-fracture test after artificial aging in a mechanical cycling machine (150 N, 5 × 106 cycles, 10 Hz). Lastly, stress distribution was assessed by three-dimensional finite element analysis (3D-FEA), simulating the specimens restoration by two types of composite resins of low and high elastic modulus (8 and 18 GPa respectively) after the access cavities. The data were submitted to Shapiro-Wilk and KS normality tests. Then, they were analyzed by one-way ANOVA and Tukey tests with a significance level (α ≤ 0.05). RESULTS CBCT scans showed a significant difference of worn tissues in CAC and TAC when compared to the IAC (P < 0.0001). In deflection test, CAC showed lower deformation values than the TAC and IAC. Load-to-fracture test presented no significant difference among the three experimental groups (P = 0.6901). 3D-FEA showed that the more conservative the access cavity, the higher the stress magnitude. CONCLUSIONS CAC promote less worn tissue; however, this does not improve the stress distribution or fracture resistance of endodontically treated maxillary incisors. CLINICAL RELEVANCE Clinicians should reconsider the pros and cons of the conservative access cavity.
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Elnawam H, Abdelmougod M, Mobarak A, Hussein M, Aboualmakarem H, Girgis M, El Backly R. Regenerative Endodontics and Minimally Invasive Dentistry: Intertwining Paths Crossing Over Into Clinical Translation. Front Bioeng Biotechnol 2022; 10:837639. [PMID: 35211465 PMCID: PMC8860982 DOI: 10.3389/fbioe.2022.837639] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
Regenerative endodontic procedures have been described for over a decade as a paradigm shift in the treatment of immature necrotic permanent teeth, owing to their ability to allow root maturation with subsequent enhancement of the tooth’s fracture resistance in addition to the potential for regeneration of vital intracanal tissues. Concomitantly, minimally invasive endodontics is another rising concept with the main concern of preservation of tooth structure. Stemming from their potential to preserve the original tooth structure, both regenerative and minimally invasive endodontics could be considered as two revolutionary sciences with one common goal. Achieving this goal would entail not only employing the appropriate strategies to recreate the ideal regenerative niche but modifying existing concepts and protocols currently being implemented in regenerative endodontics to address two important challenges affecting the outcome of these procedures; conservation of tooth structure and achieving effective disinfection. Therefore, the search for new biomimetic cell-friendly disinfecting agents and strategies is crucial if such a novel integratory concept is to be foreseen in the future. This could be attainable by advocating a new merged concept of “minimally invasive regenerative endodontic procedures (MIREPs),” through modifying the clinical protocol of REPs by incorporating a minimally invasive access cavity design/preparation and biomimetic disinfection protocol, which could enhance clinical treatment outcomes and in the future; allow for personalized disinfection/regeneration protocols to further optimize the outcomes of MIREPs. In this review, we aim to introduce this new concept, its realization and challenges along with future perspectives for clinical implementation.
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Affiliation(s)
- Hisham Elnawam
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Menatallah Abdelmougod
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Ahmed Mobarak
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mai Hussein
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Hamdy Aboualmakarem
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Michael Girgis
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rania El Backly
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Impact of Different Access Cavity Designs and Ni–Ti Files on the Elimination of Enterococcus faecalis from the Root Canal System: An In Vitro Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12042049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The present research aimed to reveal the in vitro effects of different endodontic file systems utilizing different endodontic access cavity designs on the elimination of Enterococcus faecalis from root canal systems. One hundred and fifty mandibular molar teeth were separated into three groups with respect to the access cavity design: traditional endodontic cavity (TEC), conservative endodontic cavity (CEC), and truss access cavity (TAC) (n = 50). After access cavity preparation, inolulation of teeth with E. faecalis was undertaken for 21 days. Following the first sampling (S1), further division of the groups into five subgroups (n = 10) was performed: ProTaper Gold, 2Shape, TruNatomy, Reciproc Blue, and WaveOne Gold. After instrumentation, bacterial sampling (S2) was performed. Bacterial reduction was evaluated in colony-forming units/mL, and statistical analysis was carried out. The E. faecalis count decreased significantly in all groups (p < 0.05). The range of mean values for a decrease in E. faecalis in log numbers was lowest in the TAC and Reciproc Blue groups, while the highest values of bacterial reduction were detected in the TEC and ProTaper Gold groups. The highest level of antibacterial action was obtained with the use of ProTaper Gold compared to the other file systems tested.
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Celikten B, Koohnavard M, Oncu A, Sevimay FS, Orhan AI, Orhan K. A new perspective on minimally invasive endodontics: a systematic review. BIOTECHNOL BIOTEC EQ 2022. [DOI: 10.1080/13102818.2021.2014966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Berkan Celikten
- Department of Endodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Mehrdad Koohnavard
- Department of Endodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Aysenur Oncu
- Department of Endodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Fatma Semra Sevimay
- Department of Endodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Ayse Isil Orhan
- Department of Pediatric Dentistry, Faculty of Dentistry, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Kaan Orhan
- Department of DentoMaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
- Ankara University Medical Design Application and Research Center, Ankara University, Ankara, Turkey
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Silva EJNL, De-Deus G, Souza EM, Belladonna FG, Cavalcante DM, Simões-Carvalho M, Versiani MA. Present status and future directions - Minimal endodontic access cavities. Int Endod J 2022; 55 Suppl 3:531-587. [PMID: 35100441 DOI: 10.1111/iej.13696] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
In the last decades, the move of Medicine towards minimally invasive treatments is notorious and scientifically grounded. As Dentistry naturally follows its footsteps, minimal access preparation also became a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue, backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key-points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection, and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make it clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach like minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws, but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in-situ laboratory model or a large and well-controlled clinical trial to solve this matter.
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Affiliation(s)
- Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão
| | | | | | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Shabbir J, Zehra T, Najmi N, Hasan A, Naz M, Piasecki L, Azim AA. Access Cavity Preparations: Classification and Literature Review of Traditional and Minimally Invasive Endodontic Access Cavity Designs. J Endod 2021; 47:1229-1244. [DOI: 10.1016/j.joen.2021.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 12/18/2022]
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Azarpazhooh A, Diogenes AR, Fouad AF, Glickman GN, Kishen A, Levin L, Roda RS, Sedgley CM, Tay FR, Hargreaves KM. Insights into the October 2020 Issue of the JOE. J Endod 2021; 46:1369-1370. [PMID: 32980049 DOI: 10.1016/j.joen.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Anibal R Diogenes
- University of Texas Health San Antonio School of Dentistry, San Antonio, Texas
| | - Ashraf F Fouad
- University of North Carolina, Chapel Hill, North Carolina
| | | | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | | | | | | | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, Georgia
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Silva EJNL, Lima CO, Barbosa AFA, Augusto CM, Souza EM, Lopes RT, De-Deus G, Versiani MA. Preserving dentine in minimally invasive access cavities does not strength fracture resistance of restored mandibular molars. Int Endod J 2021; 54:966-974. [PMID: 33527413 DOI: 10.1111/iej.13487] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the correlation between the volume of dental hard tissues removed and the fracture resistance of mandibular molar teeth with ultraconservative (UltraAC) or traditional (TradAC) access cavity preparations. METHODOLOGY Sixty recently extracted and intact mandibular first molars were scanned in a microcomputed tomographic (micro-CT) device, anatomically matched and assigned at random to 2 groups (n = 30), according to the access cavity type: UltraAC or TradAC. After access preparation, mesial and distal canals were prepared using Reciproc instruments and a new scan was taken. The volumes of pulp chamber and dental hard tissues in each specimen were measured before and after the experimental procedures, and the percentage volume reduction of hard tissues calculated for the entire tooth and for the crown separately. Teeth were then root filled, restored and subjected to fracture resistance tests in an universal testing machine. The force required to fracture was recorded in Newtons (N). The adherence of the variables to a Gaussian curve was verified using a Shapiro-Wilk test. Skewed data were analysed with nonparametric Wilcoxon signed rank or Spearman correlation tests, whilst the normally distributed data were analysed with a dependent samples Student t-test. Level of significance was set at 5%. RESULTS Pre-operatively, no difference was observed between groups regarding the volume of pulp canal space or dental hard tissues (P > 0.05). After access preparation, volumes of the removed hard tissues from the entire tooth and from the crown were significantly greater in teeth prepared with TradAC than with UltraAC (P < 0.05). No significant difference was observed in the fracture resistance values between TradAC (902.9 ± 347.8 N) and UltraAC (948.7 ± 405.7 N) groups (P = 0.975). The Spearman test was unable to identify a correlation between fracture resistance and percentage volume of removed dental hard tissues in the entire root (P = 0.525, r = -0.084) or only in the crown (P = 0.152, r = -0.187). CONCLUSION The volume of hard dental tissues removed, although greater in teeth with TradAC compared to UltraAC, did not correlate with the fracture resistance results, indicating that a minimally invasive access cavity did not increase the resistance of restored mandibular first molars to fracture.
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Affiliation(s)
- E J N L Silva
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - C O Lima
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - A F A Barbosa
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - C M Augusto
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - E M Souza
- Department of Dentistry II, Federal University of Maranhao, São Luis, Brazil
| | - R T Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - G De-Deus
- Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, Brazil
| | - M A Versiani
- Oral Health Center, Brazilian Military Police, Minas Gerais, Brazil
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